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Increased Mortality of Patients With Diabetes Reporting Severe Hypoglycemia
Hypoglycemia is a cause of significant morbidity among patients with diabetes and may be associated with greater risk of death. We conducted a retrospective study to determine whether patient self-report of severe hypoglycemia is associated with increased mortality.
Adult patients ( = 1,020) seen in a specialty diabetes clinic between August 2005 and July 2006 were questioned about frequency of hypoglycemia during a preencounter interview; 7 were lost to follow-up and excluded from analysis. Mild hypoglycemia was defined as symptoms managed without assistance, and severe hypoglycemia was defined as symptoms requiring external assistance. Mortality data, demographics, clinical characteristics, and Charlson comorbidity index (CCI) were obtained from the electronic medical record after 5 years. Patients were stratified by self-report of hypoglycemia at baseline, demographics were compared using the two-sample test, and risk of death was expressed as odds ratio (95% CI). Associations were controlled for age, sex, diabetes type and duration, CCI, HbA, and report of severe hypoglycemia.
In total, 1,013 patients with type 1 (21.3%) and type 2 (78.7%) diabetes were questioned about hypoglycemia. Among these, 625 (61.7%) reported any hypoglycemia, and 76 (7.5%) reported severe hypoglycemia. After 5 years, patients who reported severe hypoglycemia had 3.4-fold higher mortality (95% CI 1.5–7.4; = 0.005) compared with those who reported mild/no hypoglycemia.
Self-report of severe hypoglycemia is associated with 3.4-fold increased risk of death. Patient-reported outcomes,
COMMENT: This retrospective study basically reinforces the ACCORD and VADT that suggest that in persons with pre-existing cardiovascular disease severe hypoglycemia is a risk factor. In a VADT sub-study those subjects with low calcium scores, suggesting minimal coronary arthrosclerosis, benefited from intensive therapy whereas those with high scores were put as risk by intensive therpy.